Dental
Iconic Dental INC
Iconic Dental INC was paid $104K by Medicaid between Jan 2018 and Jun 2018, across 15 billing codes. Its largest line is D7140, Extraction, erupted tooth or exposed root — 30% of everything it billed.
33Billing provider infoICONIC DENTAL INC
WALSENBURG, CO 81089
WALSENBURG, CO 81089
33aNPI1497103691assigned 05/27/2016
33bProvider typeGeneral Practice Dentistry
28Total paid$104K
24GClaims1,430
24DCodes billed15
24AFirst – last monthJan 2018 – Jun 2018
Compared with peers
Next to other General Practice Dentistry providers in Colorado
Rank by total paid#219 of 521
Median peer was paid$53K
This provider vs. median2.0×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 1,430 | $104K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| D7140 | Extraction, erupted tooth or exposed root | 30% | 323 | 105 | $31K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | 25% | 192 | 109 | $26K |
| D5110 | 9.2% | 12 | 12 | $10K | |
| D0330 | Panoramic radiographic image | 7.2% | 152 | 152 | $8K |
| D0150 | Comprehensive oral evaluation - new or established patient | 6.6% | 185 | 185 | $7K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | 5.1% | 50 | 30 | $5K |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 3.5% | 22 | 17 | $4K |
| D1110 | Prophylaxis - adult | 3.5% | 88 | 88 | $4K |
| D0274 | Bitewings - four radiographic images | 2.8% | 105 | 105 | $3K |
| D0140 | Limited oral evaluation - problem focused | 2.8% | 88 | 87 | $3K |
| D0120 | Dental checkup, returning patientPeriodic oral evaluation - established patient | 1.7% | 80 | 80 | $2K |
| D0210 | Intraoral - complete series of radiographic images | <1% | 13 | 13 | $955.32 |
3 more codes
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialCOOPER, TACI (OFFICE MANAGER)
| Provider | Location | Paid |
|---|---|---|
| Horizon Dental PC | Salida, CO | $1.37M |
| Nickel Street Dental PC | Broomfield, CO | $3K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.